Mar 29, 2009 11:47 am US/Eastern
Insurers Deny Coverage Over Health Concerns
MIAMI (CBS4) ―
Unemployed South Floridians looking for health insurance, or small business employees who can no longer afford their employer's plans, may find it difficult or impossible to find coverage if they are currently being treated for a pre-existing condition.
''This is absolutely the standard way of doing business,'' Miami health insurance broker Santiago Leon told
CBS4 news partners
The Miami Herald.
In some cases confidential lists of what types of conditions that an insurance companies will deny coverage for can be found on the internet - with a little digging.
Being denied for a pre-existing condition is nothing new, said Leon but the number of illnesses for which a person can be denied shows just how tough it can be to find coverage.
The
Miami Herald found Sunrise based Vista, for example, had a 'confidential' guide hidden on its website. According to the guide, applicants with a wide variety of health problems should be declined coverage. Those health problems include severe acne, HIV/AIDS, Amyotrophic Lateral Sclerosis (ALS), angina, severe asthma, multiple episodes of severe back pain, hepatitis B or C, a current pregnancy and hypertension.
In addition, individuals on a number of prescribed medications should also be denied coverage according to the guide. Among the medications listed are Arava, Coumadin, Enbrel, Plavix, metformin (for diabetes), and Prolastin.
Click Here to see Vista's full list.
To make matters worse, individuals who lie about their condition can easily be caught if the insurer checks with data mining company which sells personal health information including usage of prescription medications.
In response to the guide, Vista officials issued the following statement:
The medical underwriting guidelines used by VISTA are based on industry standards, comply with all regulations and are subject to review by the Florida Department of Insurance. VISTA's Guide to Medical Underwriting is an educational tool intended to assist agents and brokers who are selling VISTA individual plans. We do not comment on our specific underwriting processes and practices.
Other insurer's guides recommend denying anyone who is too fat or thin based on their body mass index. Other reasons for denial by various companies include alcohol-related problems of people who have not been abstinent for at least six years, chronic bronchitis and severe migraines.
(© MMIX CBS Television Stations. All Rights Reserved. This material may not be published, broadcast, rewritten, or redistributed. CBS4 news partner The Miami Herald contributed material for this report)
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